Who Does—and Who Doesn’t—Qualify as a Refugee?

Last week, the United Nations High Commissioner for Refugees (UNHCR), the UN Refugee Agency, released its annual Global Trends report on forced displacement. The bottom line: Every minute in 2018, 25 people were forced to flee their homes due to war, persecution, or conflict.

In total, more than 70 million people were forcibly displaced in 2018—the highest level of forced migration in 70 years. About 3.5 million people were listed as asylum seekers, 25.9 million people qualified as refugees, and 41.3 million people were internally displaced within their own national borders. 

Across the globe, the largest numbers of refugees, asylum seekers, and internally displaced persons live in places with the fewest public resources. In 2018, countries in developed regions of the globe hosted only 16 percent of refugees, whereas nations classified as the least developed hosted one-third of the global refugee population. Refugees and asylum seekers comprise one-half of one percent of the population throughout the continent of Africa, and it’s about half that in North America. In recent years, the United States has dramatically reduced rather than increased the number of refugees admitted into the country—even though many historical and modern wars waged by the United States have contributed to forced migration.

Recently I returned from the North American Refugee Health Conference in Toronto, where I spoke about issues including asylum medicine, physician advocacy, and how to integrate health and human rights into the medical education curriculum. Refugee resettlement is always a hot topic at the conference, and this year was no different. It’s also a subject that’s difficult for many people—even experts—to wrap their heads around.

Many of my patients are refugees who have resettled in the United States, and you might be surprised to learn how many people in your community are refugees or families of refugees. You might also be surprised to discover how many famous people came to the United States as refugees—for example, Albert Einstein, U.S. Secretary of State Madeleine Albright, Nobel Laureate Elie Wiesel, singer and songwriter Gloria Estefan, and Google co-founder Sergey Brin, to name just a few. Most refugees who resettle in the United States contribute significantly to their communities, and, contrary to political rhetoric, the typical American is 29 times more likely to be killed by a regional asteroid strike than by a refugee (the chances of which are nearly nil).

As anyone who is familiar with the refugee resettlement process will tell you, it is long and difficult. In fact, the most demanding way to legally enter the United States is as a refugee.

Under U.S. law, the term “refugee” refers to someone who is located outside the United States, is of “special humanitarian concern to the United States,” and has demonstrated that they were persecuted or has a well-founded fear of persecution because of race, religion, nationality, social group, or political opinion in their nation of origin. Typically, in order to be considered as a refugee, an individual must be referred to the U.S. Refugee Admissions Program for Refugees by the UNHCR, a U.S. Embassy, a nongovernmental organization, or the U.S. Department of State. Some eligible family members living in the United States can also initiate a family reunification case— for example, for a spouse or children under the age of 21. Most people must first flee their country of origin to apply for refugee status—without firmly resettling in another nation.

If an individual is found to be eligible for consideration of refugee status, the vetting process can take years. It includes extensive background investigation, a face-to-face interview with a U.S. Department of Homeland Security Citizenship and Immigration Services Refugee Officer, health screening to identify any contagious diseases (some of which can be disqualifying), “sponsorship assurance” from an established community-based organization, and a course on cultural orientation before entering the United States. The process also includes numerous security checks through multiple federal and international databases. (Think Federal Bureau of Investigation, Department of Defense, and national intelligence agencies.) People who are rejected by the Department of Homeland Security cannot appeal the decision.

In all, less than one percent of all refugees are considered eligible for resettlement. Most live in limbo in refugee camps or shelters for years without steady access to education, employment, healthcare, or security. And more than half of all refugees are children—many of whom handle their legal cases on their own. Imagine, even as an adult, navigating such a complex system—for example: providing all necessary forms of identification after being forced to flee conflict; a composed, often intimidating interview with a professional immigration officer; a clean bill of health after living in unsafe, crowded conditions without clean water; and the fortitude to adapt to a new land after living through the unimaginable.

Self-sufficiency is a key principle promoted by the government and within refugee resettlement agencies in the United States, and it is a value commonly embraced by refugees. Refugees who are fortunate to resettle in the United States are expected to find a job within six months of arrival, and they must apply for a green card after one year, which triggers further security clearances. Many become active citizens who extoll the virtues and obligations of a free society. For example, one study found that refugees paid more in taxes than they ever received in benefits. Despite a history of trauma, language barriers, and discrimination, many refugees demonstrate remarkable resilience and independence. As I’ve written elsewhere, they are like spirited phoenixes that can rise from the ashes of adversity if given the chance.

At a time when there is a humanitarian crisis involving historic levels of forced migration, it is critical that we move beyond myths, misunderstandings, and divisive and discriminatory rhetoric. Volunteering, raising awareness, and supporting resettlement within local communities are all ways to get more involved. And—as for everyone—kindness and compassion can go a long way toward helping individuals rise from the ashes.

Photo by Rene Bernal on Unsplash.